Trouble Everywhere at the VA

October 8, 2015

A sweeping independent review of the Department of Veterans Affairs health-care system made public Friday shows the multibillion-dollar agency has significant flaws, including a bloated bureaucracy, problems with leadership and a potentially unsustainable capital budget.

The assessments, weighing in at more than 4,000 pages total, were mandated in the Veterans Choice Act, a more than $16 billion emergency funding measure passed last summer in the wake of a system-wide scandal.

The VA suffers from a system saddled with a number of different departments that can't effectively talk with each other, as well as a number of vacancies in leadership positions that need to be filled.

With an annual budget of some $60 billion, 1,600 health-care sites and 300,000 employees, the Veterans Health Administration (VHA) says it is the largest integrated health-care system in the U.S. Last year, nearly 6 million veterans were treated in the system.

The assessments found VA care outperformed non-VA care by many measures but also showed a system that needs even more change.

The report shows that the central office has grown 160% over the past five years, yet key leadership positions down the chain remain empty. More than half of the executives in the organization are eligible for retirement and could leave at any time, which could create even more leadership gaps.

Although the VA has other departments, including a benefits arm, the VHA accounts for nearly 90% of the department's discretionary budget and employee base. While the total population of veterans in the U.S. peaked around 1980 at 30 million and has declined since then, demand for VA care has been steadily increasing as greater numbers of vets take advantage of benefits. The number of enrollees and patients isn't expected to peak until 2019.